Hepatitis C
What is hepatitis C
Hepatitis C is an infectious and inflammatory disease of the liver, the causative agent of which is the virus of the same name – hepatitis C virus, characterized by an acute or chronic course. It runs for a long time asymptomatic, so it is often not diagnosed promptly. But the inflammation that has existed for years causes irreparable damage to liver cells, sooner or later leading to cirrhosis and then to hepatocellular carcinoma (or liver cancer).
To prevent complications, you should be attentive to your health – pay attention to the seemingly most innocuous changes in your condition and, if they occur, seek help from a doctor.
About the disease
According to WHO, chronic hepatitis C affects about 60 million people worldwide.
Once in the human body, the virus multiplies very rapidly and actively mutates during replication. It leads to the emergence of many subtypes of the virus and is the main reason for its eluding the adequate response of the immune system and resistance to drugs. The virus accumulates mainly in hepatocytes and immune cells – monocytes, macrophages, and others.
In the liver, the virus causes active inflammation of hepatocytes. It damages cells and, running for a long time, leads to the formation of connective tissue instead of functional tissue, resulting in the organ’s work being irreversibly impaired.
Types of hepatitis C
According to the time since infection, two forms of the disease are distinguished:
- acute (initial stage, lasts for the first six months);
- chronic (the disease lasts more than six months).
According to statistics, 70-85% of cases of acute hepatitis are subsequently become chronic, and 15-30% are characterized by self-healing.
Acute viral hepatitis C is classified according to different parameters; generally accepted classifications of the chronic form of this pathology have not been developed.
According to clinical manifestations, four periods of acute inflammation of liver cells are distinguished:
- Incubation (no symptoms of pathology).
- Prodromal, or pre-jaundice (manifestations are sterile and nonspecific: general weakness, depressed mood, a feeling of discomfort in the abdomen, stool disorders).
- Jaundiced, or period of parenchymatous hepatitis (in addition to the existing symptoms, some jaundice of visible mucous membranes and sclerae is determined).
- Reconvalescence (recovery) or transformation into a chronic low-activity course of the inflammatory process.
According to the severity of clinical symptoms, there are 3 degrees of severity of acute hepatitis C:
- mild (within a maximum of 5 days, the patient has some signs of intoxication; up to a week, there may be slight jaundice of the skin and mucous membranes, body temperature does not exceed normal values, the liver is not enlarged or slightly larger than normal);
- medium (symptoms of intoxication are expressed moderately and persist up to 1 week; jaundice is also moderate, determined within 7-10 days; body temperature rises to subfebrile values within five days, liver size 3-4 cm above normal);
- severe (manifestations of intoxication persist up to 2 weeks and more, sharply expressed, jaundice of the skin and mucous membranes is intense, persists up to 3 weeks and more, the liver is significantly enlarged, and in the stage of decompensation on the contrary – sharply reduced in size).
Reasons
Hepatitis C is caused by a virus of the same name that enters the human body with infected blood. The most frequent mechanisms of transmission are:
- injection drug abuse (injecting with a single needle);
- medical manipulations using inadequately sterilized reusable instruments;
- cosmetic manipulation (“contaminated” manicure or tattooing tools);
- unprotected, traumatic sexual contact (more common with homosexual contact in men);
- transfusion of donor blood that has not been adequately controlled for infection;
- from an infected mother to her baby;
- sharing toothbrushes and razors.
Hepatitis C is not transmitted to women or men through sneezing or coughing, hugging, shaking hands or kissing, or through water or utensils. Infection of a baby during breastfeeding from an infected mother is possible only if blood from an inflamed nipple gets on the infant’s damaged lips; in the absence of these conditions, infection through breast milk is not possible.
Symptoms of hepatitis C
During the first six months from the moment of infection, the disease, as a rule, does not manifest itself in any way – runs asymptomatic, or its signs are so weak and nonspecific that the patient ignores them and does not associate them with possible liver pathology. There is an acute hepatitis C in 15% of cases ending in recovery of the patient, who may not even assume that the disease.
But sometimes the acute form of the disease is still clinically definable, and its symptoms are similar to the manifestations of chronic hepatitis C, which will develop later:
- general weakness, fatigue;
- headache, dizziness;
- emotional instability, irritability, tearfulness, depressed mood;
- decreased appetite;
- sleep disturbance;
- heaviness, discomfort, and pain in the right side of the abdomen;
- nausea;
- joint pain;
- jaundice of the skin, visible mucous membranes, sclerae;
- dark urine, light-colored feces;
- sometimes hyperthermia.
As a rule, a patient who has chronic hepatitis experiences the above symptoms for many years, and his condition worsens significantly after dozens of years: body weight decreases, edema occurs, abdomen enlarges due to fluid accumulated in the abdominal cavity, jaundice and increased bleeding occur. These are symptoms of liver cirrhosis developed due tochronic inflammation of hepatocytes.
Diagnosis
In classic – clinically implicit – cases, the disease is detected accidentally during an examination for other pathology or prophylactic check-ups. The patient’s blood is detected with elevated liver transaminases or HCVAg (antibodies to hepatitis C), and the patient is referred to a gastroenterologist, hepatologist, or infectious disease specialist for clarification of the diagnosis.
The doctor listens to the patient’s complaints, clarifies the history of life and this disease, then conducts an objective examination, during which he will pay attention to:
- hepatomegaly;
- abdominal enlargement (ascites);
- swelling in various parts of the body;
- varicose veins of the anterior abdominal wall.
Next, the specialist will schedule a follow-up examination:
- general blood analysis (a decrease in COE, leukocytes, platelets, and an increase in mono- and lymphocytes will be detected);
- blood biochemistry (possible increase in ALAT, ASAT, alkaline phosphatase, GGT, total bilirubin, decrease in prothrombin index (PTI), total protein);
- PCR blood test to determine the genetic material of the hepatitis C virus (qualitative or quantitative);
- Blood ELISA to determine the antibody titer of each of the hepatitis viruses;
- Alpha-fetoprotein test (an oncomarker that is determined in case of hepatocellular carcinoma);
- ultrasound examination of the abdominal cavity organs (hepato- and splenomegaly, abnormal structure of the liver will be revealed);
- EGD (esophageal varices may be detected);
- Fibroscan (a method that assesses the degree of liver fibrosis – the replacement of functional hepatocytes with connective tissue);
- blood test for HIV.
Treatment
Non-medicinal methods of treatment of hepatitis C include complete withdrawal of the patient from alcohol, daily physical activity, and maintenance of average body weight.
Acute hepatitis C requires treatment only in isolated cases. The mainstay of therapy for chronic hepatitis C is specific antiviral therapy (direct-acting pan-genotypic antiviral drugs), which is prescribed to the patient for 1-2 years. All patients over 12 years of age with confirmed chronic hepatitis should receive such treatment.
In the complex treatment of this disease, hepatoprotectors, vitamins, and solutions for intravenous infusion with detoxification and/or nutritional action can be used. If severe liver failure develops, liver transplantation may be recommended.
All these treatment options are available in more than 150 hospitals worldwide (https://doctor.global/results/diseases/chronic-viral-hepatitis). For example, liver transplantation can be done in 14 clinics across Germany (https://doctor.global/results/europe/germany/all-cities/all-specializations/procedures/liver-transplantation).
Prevention
Specific prevention of hepatitis C has not yet been developed. The basis of primary nonspecific prophylaxis is:
- use for manicures, medical manipulations, only sterile tools;
- substance abuse treatment;
- safe execution of injections;
- careful testing of blood from donors for infections;
- avoiding contact with blood during sexual intercourse.
Secondary prevention (prevention of complications) in patients infected with the hepatitis C virus includes informing them about modern possibilities of diagnostics and treatment, vaccination against hepatitis A and B to reduce the probability of co-infection, and regular preventive check-ups with a doctor.
Rehabilitation
Patients diagnosed with viral hepatitis C are subject to dispensary observation by a general practitioner, gastroenterologist, or hepatologist with regular follow-up examinations and necessary to monitor the course of the disease, as well as to adjust the therapy if necessary.
